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Discussing: More Medical questions and terminology

More Medical questions and terminology

I am starting a new folder simply because the original is 67 posts long and takes awhile to load in my browser. Hope that's ok. This query is about shock. Isn't "shock" by the name, anyhow, a relatively recent phenomenon? I am wondering what M-e physicians and healers would have called it. I'm sure they would have recognised the signs... let me see what I remember from ages-ago first aid. Pallor, shallow breathing, rapid pulse... anything else? And how would they have treated it? Lying down, legs elevated, keep warm (wrap in blankets)... anything else? Or is my medical knowledge outdated? Thanks ahead of time! Lin

 

 

Re: More Medical questions and terminology

I am starting a new folder simply because the original is 67 posts long and takes awhile to load in my browser. Hope that's ok. Thanks, Lindelea, I think it was time. Isn't "shock" by the name, anyhow, a relatively recent phenomenon? I am wondering what M-e physicians and healers would have called it. I'm sure they would have recognised the signs.. Part of the problem is what you mean by 'shock' since it can mean different things to medical professionals than to the general public. There are also several types of shock. Simple fainting from something upsetting can be classified as 'psychogenic shock' which is quite different from someone with a very serious type of infection and resultant septic shock, or severe bleeding with hypovolemic shock from blood loss. Can you give me the scenario? I might be able to come up with better answers, although what you mention is good. Lyllyn

 

 

Re: More Medical questions and terminology

Can you give me the scenario? I might be able to come up with better answers, although what you mention is good. This hobbit was riding a pony... (sounds like the intro line to a bad joke, doesn't it? "This hobbit rides a pony into a bar, and...) Ok, back to seriousness now. (Think my blood sugar is low and brain not working quite rite) Ok, anyhow, he and pony are attacked by a pack of dogs who have been menacing the local sheep and now are after bigger excitement. They're in a plowed field, so the footing is bad for the mare and the dogs are able to overbalance her, causing her to fall on her rider. (But thankfully the field is freshly plowed and soft, so he's pushed down into the dirt and not badly crushed.) When the pony rolls away, the dogs attack again, pony and rider. He throws his arms up to protect his face and throat. He has a leather brace on his left arm of leather and some kind of stiffener, either wood or thin metal, and so the dog going for his throat doesn't do much damage, but another goes for his leg, I think, and probably gets a good bite in. The dogs are pulling the mare down again, excited by the fight and the blood. If they get her down, of course, it'll all be over but rescue arrives just in time in the form of a stallion who stomps the dogs and scares them off. The rider is in shock from the attack, I think, and not thinking clearly in the aftermath. Actually, I think he's "out" for a time, for another character tries to rouse him and cannot, and rides the mare to go for help. The injured character is nudged awake by the stallion, grabs the pony's mane, staggers to a nearby stump and manages to mount, rides the stallion back to the stables (he's on "automatic pilot", not a M-e term either, but you know what I mean, I'm sure), automatically puts the pony in a stall, staggers to his room and collapses on his bed, where he is found later by hobbits (would they follow a trail of splotches of blood? or do they look in and see him sprawled on the bed, sort of discovering him by accident?) who call for the healers to care for him. So I figure he's in shock, by now, from blood loss (though not life-threatening, he ought to be up and about in a week or so) and the horrendous experience. Any help you can give me on his mental confusion, state of body and state of mind, and what the healers do, would be appreciated. Thank goodness there's no rabies in England! Lin

 

 

Re: More Medical questions and terminology

Ok, I have a better picture now. Of course, I have to ask more questions before I give answers. Does he have to be 'out'? This complicates things for you as the blood loss would take some time to cause this, or be overwhelming if it occurred that fast. He can be stunned by the fall which would make him briefly unable to respond. If you truly need him unconscious, you'd have to add a head injury. An option would be to have the other character try to get him up and fail, even if he's not unconscious, with the stallion later being able to accomplish that. There is a discussion on blood loss which may help, in one of the Resource articles : Medicine: Misc. Trauma, toward the bottom of the page. Lyllyn

 

 

Re: More Medical questions and terminology

Nope, he doesn't have to be "out". The other character is a small lad up in a tree who witnesses the whole affair. He climbs down after the stallion drives away the dogs and tries to rouse the injured character. The guy doesn't have to be "out". He can be dazed from the fall (and the feeling of nearly being torn to pieces, had the stallion not intervened). The little guy can try to get him up but fail. He might even be able to tie some sort of makeshift bandage around the bleeding leg, though he's only four years old or so, for my three year old was very good at tying knots--she went through a phase of creeping up to someone, untying their shoelaces and tying them together. Where do kids get these ideas? So do you have a clearer idea of his injuries? Can you give me some kind of idea of what he'd be feeling/how he'd be acting and what the healers would do when they finally find him on his bed back home at the ranch? Well, hobbits don't have ranches (nor shoelaces for that matter) but you catch my drift. So yes, the little lad could try to get him up and fail, then grab the mare's trailing reins, lead her over to the stump, mount and ride for help. As a matter of fact, a great deal of the plot hinges on the little lad not being able to find his way back with the rescue party, giving the injured character time to be taken back to the stables by the stallion... the stables which is deserted, of course, because nearly everyone's out trying to find the injured character... quite a bit of potential for angsty humour there, i hope. I don't want to give this guy a head injury; he's had several in the course of his life... of course, he had a severe head injury several stories ago, at the Battle of Bywater when he was beaten down by a ruffian's club--that's why he wears the leather brace on his arm--(let's see, it would have been fourteen years before this incident) so I don't know if that would come into play. He's made a complete recovery except for severe headaches when the barometric pressure is low. Hope this gives you something to work with. If you have more questions, ask away. I do so appreciate your generous sharing of your time and expertise!

 

 

Re: More Medical questions and terminology

OK, here's what I'm seeing so far, correct any misapprehensions on my part. Your character is attacked by the dogs. The fall from the pony doesn't hurt him badly as specified, but he certainly could have the wind knocked out of him, leaving him briefly stunned. If you need something not too bad that the fall could do, you can always have him break a rib or a clavicle (collarbone). He's down and gets bitten, which is where it gets tricky. Shock from blood loss requires a fair amount of blood loss (see toward the top in the article for details.) He would indeed be pale with a rapid pulse and rapid breathing. If the loss is severe enough (again, covered in article) he could be confused. Once you get to the confusion stage he's lost a lot of blood - he won't recover fully in a week, more like a month. We can go into details of the bites if you need to, but to lose that much blood, the dog has to have bitten something that will bleed profusely. What a M-e healer could do is limited, you've described some of it. Lying down, absolutely. If he's lost as much blood as I think you're describing, elevating the legs is good. Blankets are good. Other things: Stop the bleeding - this is at the top of the list, assuming no injuries to his airway and no breathing problems. Wash out the wound to minimize the risk of infection. (If Athelas fits in your story, by all means use it.) Assuming no injury to the abdomen, get him to drink as long as he is conscious. This is the healer's only route to replacing some of what he's lost. For the next few weeks he needs to eat foods high in iron. Some examples are given in the article: liver as the best source, then spinach, red meat, pumpkin seeds, and certain types of beans. Lyllyn

 

 

Re: More Medical questions and terminology

I did read the blood loss article for another story, some time ago, but still remember a fair amount. I'm not sure he can break a collar bone, not unless he'd be able to ride a race a week later with it bound up... Timeline here: (he's out searching for missing kid) Sees kid in tree, hears dogs baying, starts across newly ploughed field. Perhaps he shoots an arrow at the dogs. Dogs turn to attack pony. (nassty viciousss creatures. hungry, too) Character starts to beat dogs off, pony loses footing and goes down on top of character in soft, ploughed dirt Character stunned, pony struggles to rise, takes a few steps away as dogs fasten onto pony and character Stallion shows up and kicks, um... well, let's just say he kicks. And stomps. And bites, and all that sort of thing. Stallion chases dogs away. Kid descends tree, tries to rouse character. (Character not necessarily unconscious, but dazed and barely responsive) Kid grabs mare's reins, leads her to stump next to tree, mounts and rides for help. Stallion returns, nudges character, character gets a grip on stallion's neck/mane, stallion pulls him to his feet. He blearily leads stallion to stump (he's actually very confused at the moment, thinking this particular stallion is actually another pony, is this getting too complicated?), manages to mount, lies down on stallion's neck, hanging onto neck and/or mane, stallion ambles home just as if he's some old, docile plough pony. Character falls off in stable yard, gets up holding on to pony again, in a mental fog he puts pony away in (other pony's, the one he mistook stallion for) stall, stumbles across the yard to the Great Smials, in through entrance, down familiar corridor to his own refuge (his room), falls on bed and knows no more. (a swoon? not really unconscious because he's knocked out, but because he's home and safe and been through a horrendous experience) Actually, there's a possibility that another littler kid (a toddler who looks on him as a favourite uncle) finds him before anyone else, climbs onto the bed, tries to waken him, and then snuggles down under his arm and falls asleep. But I'm still working that out. He's found some time later and the healers get their claws into him: Washing torn flesh and applying antiseptic, which in my experience stings, and applying arnica to bruises, and rousing him so they can pour fluids into him, and finally bandaging him and shucking him out of his torn, filthy clothes and into nice clean nightshirt and tucking him up with hot bricks wrapped in flannel and blankets and perhaps his feet elevated and all that nice "c" stuff that comes after the "h" in h/c... The clincher is that he has to be fit to ride in (and nearly win) a pony race in a week or so. Can it be done?

 

 

Re: More Medical questions and terminology

Thinking about it again, these are my constraints. The pony falling on him is a given. That's why I made it a freshly-ploughed field. Also givens: The dog pack attack and bite(s) (may be more damage than just the leg, but nothing permanently crippling), some blood loss, obviously, but he cannot bleed nearly to death. The loss of blood can be steady, but must be slow (perhaps speeds up somewhat with effort or exercise on his part). He's going to be lying in the dirt for half an hour at least (maybe a bit more) and he has perhaps a half hour slow ride to get home, time to put the pony away and stumble to his room, and some more time lying on his bed before he's discovered. He must be fit to ride (he can be limping, he can have healers protesting all over the place and trying to keep him in bed; he's rather well known for doing that sort of thing) and nearly win a pony race in a week to ten days. That is already written in a published story (this is a prequel of sorts, and the published story refers back to the upcoming race and mentions that his pony took second place--not the one attacked by dogs, BTW) Edit: Perhaps we are talking a combination of shock from injury and ... what did you call it? psychogenic shock? from nearly getting eaten alive by dogs? Can you give me an injury scenario that fits this?

 

 

Re: More Medical questions and terminology

Perhaps we are talking a combination of shock from injury and ... what did you call it? psychogenic shock? from nearly getting eaten alive by dogs? The psychogenic shock would be brief - most people would know this as fainting. The technical definition of shock is that there is not enough blood and oxygen getting to the vital organs. So for fainting this would be a matter of seconds to a few minutes maximum. Shock from his injury would have to be due to blood loss, and to be confused, his blood loss would have to be pretty severe. Maybe I can help better if I undertand just how confused he has to be? Lyllyn

 

 

Re: More Medical questions and terminology

Maybe I can help better if I undertand just how confused he has to be? He has to be logy (is that how you spell it?) when the little kid is trying to rouse him enough to get on the mare and ride home, such that the kid gets on the mare and goes for help. Would this describe someone recovering from a faint? Or maybe he's in the swoon while the kid is trying to rouse him, and he wakens after the kid has taken off on the mare. He has to be confused enough to mistake a grey pony with a star on his forehead for a very similar grey pony without any markings. (Perhaps the grey pony with a star is very dirty, or perhaps he reaches for the pony with a blood-smeared hand and smears blood over the star, covering it.) He rides this pony homewards and puts him in the other pony's stall (the other pony is out, being ridden by someone in the rescue party searching for our hero!) He stumbles to his bed (remembering he has an injured leg) and collapses on it. His only thought is sleep. I suppose if he's suffering blood loss he could also be aware of thirst, downing a cup of water from the pitcher and mug on the nightstand, before collapsing on the bed. He still has to be able to ride in a horse race in a week, ten days at the outside. Does this help, or am I just going to have to stretch believability...?

 

 

Re: More Medical questions and terminology

Does this help, or am I just going to have to stretch believability...? No, that helps and I think we can work with it easily. Here's what I would see - initial injury, stunned and in pain. Little child tries to get him up, he's not unconscious but he's not very cooperative and not moving well, won't initially put weight on the leg, either. Child rides off. Our Hero is in pain, and focused on getting home - home is comfort, warmth and rest. A horse wanders up, he's not really thinking about the horse, (although the devices you mention would work also). Often people take their cue from context - just like I might walk up to the wrong car in a parking lot if it's where I usually park and has the same vague shape and color. So if he expects to see grey horse A and finds grey horse B, that's an understandable mistake to make. Kind horse helps him up, he rides and stables pony. All this time he's had a steady slow blood loss. (It can be worse at first and he can put something around it to slow it, or it can be slow and steady throughout. He stumbles to bed. With this scenario he could indeed leave an impressive blood trail for his friends to follow. He is found in bed. I would suggest a moderate blood loss, with most of the confusion coming from pain and focusing on getting himself home. With iron rich food and plenty of liquid he will not be 100% recovered, but could very well ride a race. If it helps the plot, he could feel dizzy if he stands suddenly instead of slowly, continue to be pale for a week or so, and generally look like hell. HTH Lyllyn

 

 

Re: More Medical questions and terminology

Oh, hurrah, now I can write the chapter! Thanks so much for the help!

 

 

Re: More Medical questions and terminology

He has to be confused enough to mistake a grey pony with a star on his forehead for a very similar grey pony without any markings. (Perhaps the grey pony with a star is very dirty, or perhaps he reaches for the pony with a blood-smeared hand and smears blood over the star, covering it.) the star would likely be indistinct on a grey pony old enough to ride and I would imagine it would not be difficult to confuse one with a star and one without.

 

 

How to break a leg (or not)?

I have another question about how to mess up my favourite Ranger's health (still for the same story, Doomed to Live"). I have the following scene in mind: The unfortunate prisoner (aka Aragorn) is held on his knees by the Uruk-hai. They take one leg (image in my head says it's the left one), hold it by the ankle, extend it to the side (so that it is slightly twisted) and then hit Aragorn hard above the ankle (outer side of the leg) either with a club, the broad side of a sword or step/jump on it. How severe would the resulting injury be? Is such a blow strong enough to break the fibula (yes, I already read that excellent research article ... more than once ... hence my knowledge of the names of the bones in the lower leg)? Would the tibia be affected as well? What about the joints (as I assume that Aragorn's leg is held by the ankle, I doubt that the ankle would be injured as well, but I am not so sure about the knee)? A broken fibula would work wonderfully for the purpose of my story, but I have no idea how to 'achieve' it. My roommate had a horse step on his leg at about the same area I had in mind (a hand's breadth above the ankle; I wanted to go for a bit lower than that) and came away with a scratch and a rather nasty contusion, but nothing worse. Any of you remember Kathy Bates in "Misery" (film-version of Stephen King's "She" I think)? and the way she made sure that her captive would not escape? I am thinking about something along those lines only that I think King had her hit the poor man's ankles. I hope I managed to get across what I am looking for. TIA, fliewatuet

 

 

Re: How to break a leg (or not)?

I'm sorry Fliewatuet, that I still haven't sat down to read for a while, so am behind on your story. On to the medical question. I'm assuming that you want an isolated fibula fracture. What you've described should work. I wouldn't go too close to the ankle, or you're risking ankle damage as well which is a more serious proposition. The tibia is a fairly large strong bone, much thicker that the fibula, so it would take far more force to break both; and the mechanism you've proposed would not be likely to do so. [whimpers for poor Aragorn] Lyllyn

 

 

Re: How to break a leg (or not)?

Thanks again for the help! [whimpers for poor Aragorn] Uh, did I already mention that he is in for a rough time? I know that he hates me ... fliewatuet

 

 

How to fix a leg (O Lyllyn!?)

O my, I really feel for Aragorn and his broken leg! *** Lyllyn, I have got my hero to his bed, and the healer has found him there and just lifted the blanket to begin his examination. I assume he might not treat him in his bed, after all, the hobbit is filthy from being half-crushed down into the soft dirt of the plowed field, and his leg is covered in bloody bandage and there's a dog bite underneath. I'm assuming the dog sank in its teeth and worried the leg, so what kind of injury are we talking? I want this to heal fairly normally. I assume the healer would do a quick assessment and take care of the bleeding first... but he's filthy. What do you do in this circumstance? I assume something needs stitching, but does he stitch first and then wash or wash first, quickly, and then stitch? This is why I'm assuming they carry him from his bed to a table in the infirmary or some such. It could really mess up a bed to treat someone, who's covered with dirt, for a badly bleeding leg. Would he stitch just the bleeder(s) and leave the wound open for a while (like how long?)? I assume the healer would be worrying about the possibility of "red swelling". What precautions would he take? Would it be likely to avoid infection completely, or more likely that there would be some infection, in which case, I assume they'd treat it with hot poultices and perhaps loosening the stitches to let it drain... Would they put him in a bath? He's cold from shock and blood loss. I figure they'd elevate the leg, keep it out of the bath water? I have him wakening all clean, in a bed with clean sheets, with his leg propped up on pillows and nicely bandaged. Added to this is a bruise on his ribs from another dog's iron grip, though I don't think the dog would have cracked a rib, or would he? Another dog had him by the arm, but he had a reinforced leather brace on the arm and so I don't think it would be damaged. Anyhow, if you could give me an idea of what the healer would do... it would be a help. I know the injured character's going to be eating lots of liver and red meat and spinach and such, and drinking lots. I know he's going to have to keep the leg elevated for a few days. I think he's going to sneak out to ride in the race in a week... Whew, thanks, Lin

 

 

By the way...

Have begun uploading chapters of the pony story to HA, under the name "StarFire", if anyone's curious.

 

 

Re: How to fix a leg (O Lyllyn!?)

I'm assuming the dog sank in its teeth and worried the leg, so what kind of injury are we talking? I want this to heal fairly normally. It can be set up a variety of ways. I'll indicate what would heal well but have a large scar. I assume the healer would do a quick assessment and take care of the bleeding first... but he's filthy. What do you do in this circumstance? I assume something needs stitching, but does he stitch first and then wash or wash first, quickly, and then stitch? No stitching until it is very well washed. Washing is your main infection control method, even today - antibiotics are for when control has failed or has a high risk of failing. … I'm assuming they carry him from his bed to a table in the infirmary or some such. Would he stitch just the bleeder(s) and leave the wound open for a while (like how long?)? Here's what I'd think would happen: If he's still bleeding steadily (IIRC, you already specified it wasn't an arterial bleed, pumping, or he might have bled out already.) take a clean cloth and put direct, firm pressure on the wound. While someone is holding that pressure, carry him to where ever the healer will work. An infirmary, if they have one, is great. A kitchen table is reasonable. A table in a bathing room is even better, if the room and table are large enough. Prepare equipment the healer may need. (The wound article has this.) If the bleeding is still steady and brisk - not just oozing or a very slow leak - tying the bleeding vessel would be next after a preliminary wash out. If the bleeder is pumping, tie before the wash out. Next is an extensive wash. Have some one take pitchers of clean water (in modern day we'd know to boil it first, but even clean is good) and pour it into the wound, then let it drain out, or even rotate the leg a little so it can drain. Do that several times. Given the circumstances, I'd advise at least a liter or 2 quarts of water, and more is better. They probably would assign someone to wash the rest of him, working around the healer. They would have that person dry him well to reduce heat loss, and warmly wrap anything that doesn't need to be exposed for the healer to work on. Any parts that couldn’t be cleaned without getting in the healer's way would wait until the leg was treated, then the washer could finish. I assume the healer would be worrying about the possibility of "red swelling". What precautions would he take? Would it be likely to avoid infection completely, or more likely that there would be some infection, in which case, I assume they'd treat it with hot poultices and perhaps loosening the stitches to let it drain... I must confess I'm not familiar with the term 'red swelling'. Certainly something infected is red and swollen, and certain types of infection will cause red streaks to go up the leg or arm. Assuming you mean infection, I'll cover that as we go on. Next examine the wound. What's damaged? From what you've already said, I assume some tearing of the muscle. Tendon injuries have a higher rate of infection - I'd suggest avoiding those. Bone can be damaged (think pit bull) but doesn't have to be. In M-e nerve damage would be an issue since there is no possibility of repair. Checking for nerve damage would involve checking function rather than actually looking at the nerve. I don't know that you need to do anything with this information, but if you want to introduce drama by being concerned about it, it's medically correct. Any tissue that's been so mangled it's going to die, or has already died, must be removed to decrease the risk of infection - this is called debridement from the French, and is very important for infection control. Who knows what it would be called in Middle-earth - I sure don't. Maybe someone can tell you 'cutting' or 'removal' from the Sindarin? Now the issue comes up - this can be done by currently known principles, or by what many might have thought reasonable in the past, even though we may know better now. If by current principles, tie off any vessel that must be tied to stop bleeding. If there are large tears in the muscle that won't heal otherwise, put in as few sutures as you can get away with to bring it together. Any additional material in the wound increases the risk of infection, and this is an infection prone wound. If there is a large area laid open (a dog's teeth could hook into the skin and tear a large flap open) a few loose stitches to close the flap is reasonable. The stitches are loose so fluid can drain instead of collecting. If not using current principles, the healer might do a lot more sewing, trying to put everything back together as closely as possible to normal. Would they put him in a bath? He's cold from shock and blood loss. I figure they'd elevate the leg, keep it out of the bath water? I doubt they'd put him in a bath unless the hypothermia appeared to be a danger. One thing you could use is whether he's shivering or not. If he's cold, but shivering, rewarming without the bath is reasonable - get him to drink hot liquids. HTH Lyllyn

 

 

Re: How to fix a leg (O Lyllyn!?)

O, thank you, Lyllyn. I think I can write that part now. I simply could not visualise it before. I was going to take the cowardly way out and simply skip the clock forward a few hours... I appreciate the detailed and easy-to-visualise reply. Yes, "red swelling" is what I call infection in my stories. "infection" sounds so... modern... somehow. (like "shock", though I haven't found a more hobbity word or phrase for that yet) So, fluid drains for... a day or two? and then they stitch everything closed? I don't think I'm going to worry too much about nerve damage, unless that would be unrealistic. Glad to hear bone damage isn't necessary. I do want him, even though he's not going to be able to walk well for the near future, to be able to ride, and you really ought to have two functional legs for that (even if one is painful). Do you suppose he would lengthen the stirrup on the injured side, or shorten it? (one would straighten the injured leg, the other would flex it more but I think put more of his weight upon the other leg. Not sure, will have to think on that and perhaps consult Sulriel)

 

 

Re: How to fix a leg (O Lyllyn!?)

So, fluid drains for... a day or two? and then they stitch everything closed? I'd estimate longer from the injury you're describing - probably 4 or 5 days. And I think they'd leave it at the few loose stitches needed to close it. If it's so extensive that it needs further stitching, after 3 to 5 days they could do a delayed closure. Someone doing that type of closure would trim the edges of the existing wound to get 'fresh' edges to sew. I don't think I'm going to worry too much about nerve damage, unless that would be unrealistic. You can ignore that completely with no problem. Do you suppose he would lengthen the stirrup on the injured side, or shorten it? (one would straighten the injured leg, the other would flex it more but I think put more of his weight upon the other leg. Not sure, will have to think on that and perhaps consult Sulriel) I plead complete and utter ignorance here! Lyllyn

 

 

Re: How to fix a leg (O Lyllyn!?)

How would his range of motion (of the ankle) be affected? and would the leg (calf) be contracted from the stitches or bandage?

 

 

Re: How to fix a leg (O Lyllyn!?)

How would his range of motion (of the ankle) be affected? and would the leg (calf) be contracted from the stitches or bandage? If the injury is higher up the leg, say the calf, there would likely be no permanent effect on the range of motion of the ankle. In the short run, it would hurt to move the muscles involved, but he could do it. Maximum pain and swelling would usually be at 3 days, a week later, still very sore. I would not expect any contractures on the injury as set up. The healer would be likely to advise bed rest for several days, then mild activity for another 1-2 weeks. He could use the leg more, but it's not smart. If Lindelea structures the original injury as tears with the grain of the muscle instead of across, or chewed up areas but most of the muscle is fine (it is a big muscle) then there wouldn't be as much injury to stress. Lyllyn

 

 

Re: How to fix a leg (O Lyllyn!?)

Back once more... cannot seem to let this thing go. During the week after, you said he'd have the most soreness by about day 3, but his leg would still be pretty sore after a week. During the recovery time (I know, he's not recovered in a week, but he's recovered enough to be stupid enough to ride in a race), would there be a time when he's restless and feverish? Could it appear that he's fighting infection, without getting a full-blown red-lines-creeping-up-the-leg-and-considering-amputation type of deal? How would the healer deal with this? Release the stitches for drainage, I suppose--for how long? And hot poultices? And willow-bark tea, I imagine, for pain, fever, and inflammation. About what day would signs of infection appear? As early as the second day? And how long would a mild infection take to clear up? Now for what happens on race day: Here's the scenario. Someone's going to help him sneak out of bed on race day, to ride his pony in the final race. (Someone else rode her in the heats, and she qualified to run in the final, and our hero will be changing clothes with the other rider and wearing a scarf over his face (ostensibly to keep out dust, but also good for not being recognised). What kind of progress do they make, walking from his room to the stables? (Arm pulled over shoulder, hopping along? Would he put much if any weight on the affected side?) His cohorts boost him into the saddle and he discovers he's afraid he'll lose his stirrup, so they tie his leg to the stirrup leathers (thanks, Sulriel, for that suggestion. Ferdi is just stupid reckless daft enough to do this if it means the difference between winning and losing) I know you don't know much about riding. I'm pretty sure he's not going to be doing much squeezing of the pony's side with the damaged leg. (Imagine you're sitting on a barrel, your legs apart. Press your heels down and slightly out, I think, though it's been a long time. Squeeze your calves inward, or press one leg against the barrel a little harder than the other--these are some of the ways legs are used in riding. Can you tell me what is happening to the injured leg, with this sort of mental picture?) I assume that putting weight on the foot will be painful. Any and all help muchly appreciated. I am currently writing the chapter of his week in bed, and the next chapter after that is the race...

 

 

Re: How to fix a leg (O Lyllyn!?)

During the recovery time (I know, he's not recovered in a week, but he's recovered enough to be stupid enough to ride in a race), would there be a time when he's restless and feverish? Could it appear that he's fighting infection, without getting a full-blown red-lines-creeping-up-the-leg-and-considering-amputation type of deal? How would the healer deal with this? Release the stitches for drainage, I suppose--for how long? And hot poultices? And willow-bark tea, I imagine, for pain, fever, and inflammation. He would be restless and feverish only if you decide that he gets an infection, and you should take into account that will slow the recovery. He could get a superficial infection as opposed to the red streaks up the leg which indicate infection in the lymph channels (sorry, more than you want to know, I expect!) Infection can be very surface - say just around one suture, or pus from the wound and a large red area, or involve the whole limb. The larger the area you involve, the more you will slow things down. If he has an infected wound, he's risking a lot more by riding, since he should be on fairly strict bedrest at that point. If you do decide on an infection, if it's just around a stitch, remove it. If it's the whole wound, or most of it, remove all stitches. Hot poultices are fine, but take care not to burn the skin. Willowbark tea is good. The other thing that would be done for more than a very small area of infection is to make sure all dead tissue is debrided. The healer would open the wound, and cut away anything that didn't look healthy. If you have to open the wound, I'd say letting him ride is a real risk at this point. About what day would signs of infection appear? As early as the second day? And how long would a mild infection take to clear up? It could be as early as the second day. Two days after is the time of highest likelihood for an infection to appear. If it's an infection around a suture, and the suture is removed, it could look better in a day or two. A larger infection would take several days to improve - probably won't work with your timetable. If you need something to improve fast either make it small and around a stitch, or small and around an area where the surface skin looks to be dying. (more details on appearance of this supplied if needed.) Then the healer can cut away the bad part, and he can improve within 2 to 3 days. Now for what happens on race day: What kind of progress do they make, walking from his room to the stables? (Arm pulled over shoulder, hopping along? Would he put much if any weight on the affected side?) Again, depends on how bad you've made the original injury (I'll try to find that part to read). The less he makes the injured part do, the better. If you haven't indicated too much damage to start, walking with a stick as a cane is reasonable. I know you don't know much about riding. Nothing! I'm glad Sulriel and others are around! I'm pretty sure he's not going to be doing much squeezing of the pony's side with the damaged leg. (Imagine you're sitting on a barrel, your legs apart. Press your heels down and slightly out, I think, though it's been a long time. Squeeze your calves inward, or press one leg against the barrel a little harder than the other--these are some of the ways legs are used in riding. Can you tell me what is happening to the injured leg, with this sort of mental picture?) I'm going to make some assumptions, and you can tell me if any of these will not work. He was lying on his side when attacked, so the bite should be either outer aspect or the back of leg. You needed steady blood loss, so it's more than just skin, there's some muscle chewed up. I'd recommend the damage limited to a big muscle so the rest of it will still function well. That would make it the gastrocnemious, or possibly the soleus, and you could have both involved very easily. These are used to lift the heel off the ground, and are very important for walking, leaping, etc. The gastrocnemious also helps to bend the knee, but there are other muscles involved as well. The soleus also steadies the leg while standing. I assume that putting weight on the foot will be painful. Yes, although it might not be very bad a week later with good healing - more sore. Walking would be worse. HTH Lyllyn

 

 

Re: How to fix a leg (O Lyllyn!?)

He would be restless and feverish only if you decide that he gets an infection, and you should take into account that will slow the recovery. He could get a superficial infection as opposed to the red streaks up the leg which indicate infection in the lymph channels (sorry, more than you want to know, I expect!) Infection can be very surface - say just around one suture, or pus from the wound and a large red area, or involve the whole limb. The larger the area you involve, the more you will slow things down. If he has an infected wound, he's risking a lot more by riding, since he should be on fairly strict bedrest at that point. Yes, this is what I'm looking for. The idea is to slow his recovery just enough to make riding in the race a really stupid and difficult/challenging thing to do... which makes him and his pony nearly winning the race a real testimony to grit and determination (and... idiocy?) If you do decide on an infection, if it's just around a stitch, remove it. If it's the whole wound, or most of it, remove all stitches. Hot poultices are fine, but take care not to burn the skin. Willowbark tea is good. The other thing that would be done for more than a very small area of infection is to make sure all dead tissue is debrided. The healer would open the wound, and cut away anything that didn't look healthy. If you have to open the wound, I'd say letting him ride is a real risk at this point. A real risk of what, exactly, please? I'd like to know what my options are. (Besides, the friend who's editing my stories is depressed and overworked right now, and for some reason Ferdi-angst makes her feel much *better* for some reason--she gives so generously of her time I'd like to be able to do a little something for her in return.) So would it be unrealistic for him to hobble out of the infirmary on the arm of a co-conspirator, someone he's roped into his plan? [The onset of infection] could be as early as the second day. Two days after is the time of highest likelihood for an infection to appear. If it's an infection around a suture, and the suture is removed, it could look better in a day or two. Let's see, that would be Day 1 injury Day 3 likelihood for infection to appear (when would the first signs show--and would they be fever? restlessness? achiness? ...or would it be more likely that someone changing the dressing would notice redness before fever, etc. appeared?) Day 5 looking better (but still on strict bed rest?) Day 7 race day (on bed rest still? having to sneak out to the race?) A larger infection would take several days to improve - probably won't work with your timetable. If you need something to improve fast either make it small and around a stitch, or small and around an area where the surface skin looks to be dying. (more details on appearance of this supplied if needed.) Then the healer can cut away the bad part, and he can improve within 2 to 3 days. I don't think I need to get graphic, just need to be able to understand what's happening to the character, mostly what he's feeling, over this time frame. He's not going to be looking at the wound himself, since as you guessed it is on the side/back of the calf. I suppose it would help to know what a healer sees. Again, depends on how bad you've made the original injury (I'll try to find that part to read). The less he makes the injured part do, the better. If you haven't indicated too much damage to start, walking with a stick as a cane is reasonable. I can see him walking with a stick as a cane, hmmm, or leaning on a person. I know you don't know much about riding. Nothing! I'm glad Sulriel and others are around! Me too!!! I'm going to make some assumptions, and you can tell me if any of these will not work. He was lying on his side when attacked, so the bite should be either outer aspect or the back of leg. You needed steady blood loss, so it's more than just skin, there's some muscle chewed up. I'd recommend the damage limited to a big muscle so the rest of it will still function well. That would make it the gastrocnemious, or possibly the soleus, and you could have both involved very easily. These are used to lift the heel off the ground, and are very important for walking, leaping, etc. The gastrocnemious also helps to bend the knee, but there are other muscles involved as well. The soleus also steadies the leg while standing. How about the muscle you use to force the heel down? This is an important part of a rider's balance. I remember from early lessons that when my heel(s) came up, my balance was gone. I figure then that he can probably move the leg to give signals to the pony, but even subtle shifts are going to hurt like the dickens. I assume that putting weight on the foot will be painful. Yes, although it might not be very bad a week later with good healing - more sore. Walking would be worse. Did you mean "more sore than painful" as in degrees of discomfort? How long would you expect him to walk with a limp? I'm anticipating that they pop him into bed for another week, at the end of which he badgers them into letting him up. Guess he'd be walking with a cane, but still able to work with a horse after the second week (that would be, a week after the race). You don't think riding in a race would set him back in his recovery to any significant amount, do you? I need him to be training a horse in a week or two after the race (so, two to three weeks after the original injury) Whew! I've written another l-o-n-g post, sorry. HTH Lyllyn You have been an immense help. The story would have been so much less to my satisfaction without the expertise you've supplied. I might not have finished it, even... what a terrible thought! (I hate it when people don't finish their stories) Oh, and my editor-friend says "Thank you very much". I think all the "c" in the h/c combination has cheered her considerably.

 

 

Re: How to fix a leg (O Lyllyn!?)

Forgot to mention that the injury and healing chapters are up at SoA but I haven't got them transferred over to HA yet. (Have got up to chapter 5, here, though, and working steadily). Appreciate your looking over the injury-recovery chapters to see if I've made any boo-boos or if they stimulate any suggestions... Thanks again, Lin

 

 

Re: How to fix a leg (O Lyllyn!?)

If you do decide on an infection, if it's just around a stitch, remove it. If it's the whole wound, or most of it, remove all stitches. Hot poultices are fine, but take care not to burn the skin. Willowbark tea is good. The other thing that would be done for more than a very small area of infection is to make sure all dead tissue is debrided. The healer would open the wound, and cut away anything that didn't look healthy. If you have to open the wound, I'd say letting him ride is a real risk at this point. A real risk of what, exactly, please? I'd like to know what my options are. (Besides, the friend who's editing my stories is depressed and overworked right now, and for some reason Ferdi-angst makes her feel much *better* for some reason--she gives so generously of her time I'd like to be able to do a little something for her in return.) With a large open wound there are several issues. Firstly, if he's riding, there's going to be pressure, even if only from his clothing, rubbing against the area. Keeping the injured part immobilized is important - lots of use can spread the infection beyond the original area, also put stress on the injured muscle, rip out any stitches that were placed, or start the area bleeding again. You can believably write him as lucky nothing serious does happen, however. There are some Very Nasty types of infection he could get, which could kill him within a few days, but I expect you will not want to use those, except perhaps to have the healers threaten him with it or tell him how lucky he is to avoid them. Gas gangrene would be one type, 'flesh eating' (actually a particular type of strep infection) would be the other. Tetanus was a real killer before immunizations, and farmyard accidents were a frequent source. Day 1 injury Day 3 likelihood for infection to appear (when would the first signs show--and would they be fever? restlessness? achiness? ...or would it be more likely that someone changing the dressing would notice redness before fever, etc. appeared?) Day 5 looking better (but still on strict bed rest?) Day 7 race day (on bed rest still? having to sneak out to the race?) The earliest signs are likely to be redness and swelling with the possibility of increasing pain, if the infection is on the skin. If it is deep in the wound, likely increased drainage, possibly with more pain. One thing to be aware of - fever means the infection is more serious, and the risk gets much higher that the infection has spread and could become life or limb threatening. How about the muscle you use to force the heel down? This is an important part of a rider's balance. I remember from early lessons that when my heel(s) came up, my balance was gone. Those muscles are on the front of the leg. I figure then that he can probably move the leg to give signals to the pony, but even subtle shifts are going to hurt like the dickens. Probably. And anything that involves using the injured muscle will be painful, and it will increase with repetitive use. I assume that putting weight on the foot will be painful. Yes, although it might not be very bad a week later with good healing - more sore. Walking would be worse. Did you mean "more sore than painful" as in degrees of discomfort? Exactly, sore with standing. It would get considerably more painful as he continued with activity. How long would you expect him to walk with a limp? This varies with the original injury. Range would be 2-3 weeks with mild initial injury and good healing (and following instructions, dammit!) up to about 6 weeks. You don't think riding in a race would set him back in his recovery to any significant amount, do you? I need him to be training a horse in a week or two after the race (so, two to three weeks after the original injury) It will slow things down somewhat, but it needn't be that bad. If he doesn't reinjure it, if he didn't have any significant infection (that will slow things by at least a week, and could be two or three) if he is reasonably young and healthy, three weeks for mild activity is reasonable. If you forget the infection entirely, I'd say you'll get away with two. However, it depends on what he needs to do to train a horse. What will it entail in terms of physical effort and specific actions? Oh, and my editor-friend says "Thank you very much". You're welcome.

 

 

Re: How to fix a leg (O Lyllyn!?)

How long would you expect him to walk with a limp? This varies with the original injury. Range would be 2-3 weeks with mild initial injury and good healing (and following instructions, dammit!) up to about 6 weeks. I'm afraid Tooks aren't very good at following instructions. They seem to think life is just one big hobbit walking party. You don't think riding in a race would set him back in his recovery to any significant amount, do you? I need him to be training a horse in a week or two after the race (so, two to three weeks after the original injury) It will slow things down somewhat, but it needn't be that bad. If he doesn't reinjure it, if he didn't have any significant infection (that will slow things by at least a week, and could be two or three) if he is reasonably young and healthy, three weeks for mild activity is reasonable. If you forget the infection entirely, I'd say you'll get away with two. However, it depends on what he needs to do to train a horse. What will it entail in terms of physical effort and specific actions? I will probably go with a mild-to-moderate infection, rather than forgetting it entirely, as I'd otherwise expect him to be up out of bed before a week, and then his riding in the race wouldn't come as such a shock ... Well, the ground work he could do standing, leaning on a cane, but there will be riding as well--getting the pony used to working under saddle (he's trained, but rusty), breezing around a track, speed and endurance work, even some workouts with other ponies, that sort of thing, to get ready for a race. Basically, riding... without the intensity involved in a race, yet much longer in duration. Does that help?

 

 

Re: How to fix a leg (O Lyllyn!?)

Just kind of sped-read through this thread, and I am not entirely sure how well one can ride with a badly injured leg. If the character can bear weight on it, he can probably ride. But it is hard to ride well. Doing anything more than just walking takes a fair amount of leg muscle. It doesn't look like it, but it does. And also, the movement of the horse at the trot and canter jolts you around. Especially on a pony, since most (not all, but a lot) of ponies have gaits that feel like sitting on a jackhammer. It can be done and it has, but ouch.

 

 

Re: How to fix a leg (O Lyllyn!?)

Just kind of sped-read through this thread, and I am not entirely sure how well one can ride with a badly injured leg. If the character can bear weight on it, he can probably ride. But it is hard to ride well. Doing anything more than just walking takes a fair amount of leg muscle. It doesn't look like it, but it does. And also, the movement of the horse at the trot and canter jolts you around. Especially on a pony, since most (not all, but a lot) of ponies have gaits that feel like sitting on a jackhammer. It can be done and it has, but ouch. Whew, glad to hear it can be and has been done. Well, with the badly injured leg, he's going to do a little walking (to the racecourse) and then he's going to sit very still for just a bit and then he's going to be leaning forward on a pony going at top speed for a mile or so and then... Well, let's just hope his leg doesn't fold up under him and make him fall off, since Sulriel has so wickedly introduced me to the idea of tying the leg to the fender. Yikes. I know about that leg muscle! I remember feeling like all I wanted was a long hot soaking bath after a long session with my instructor... but of course the horse came first, and then the drive home, and by then I'd be tired enough just to fall into bed and forget the bath. I'd guess he wouldn't be posting well with his calf muscles torn, would he? I forget, do you post from the ball of the foot or from the knee? It has been 20 years since I said goodbye to my mare, and we moved where horses were inconvenient and very very expensive, even to rent... and then, years later, when we moved to where we could have a horse again, my knees had given out. I have tried riding in pain, and decided I'd rather live with good memories. Drat. Haven't ridden with a torn calf muscle, though. Having a little trouble imagining it, so any further advice on how he feels & copes would be very welcome! Thanks, Lin

 

 

Re: How to fix a leg (O Lyllyn!?)

Oooh... Torn calf muscle = bad for racing. When you race (or jump), you kind of stand in the stirrups and bend forward. All your weight should be in your heel. In other words, you are supporting yourself with mostly your calf. It would be really hard to stay on if you couldn't use your calf muscle.

 

 

Re: How to fix a leg (O Lyllyn!?)

In other words, you are supporting yourself with mostly your calf. It would be really hard to stay on if you couldn't use your calf muscle. Ummm, aside from sheer grit and determination, what do you think of some sort of support for the leg, like having it tightly bound?

 

 

Re: How to fix a leg (O Lyllyn!?)

That might be a good idea... No matter how much pain you're in, you'll stay on. And the leg will be supported. And painkillers! Think M-e has an herbal equivalent of morphine or vikodin (sp?)?

 

 

Re: How to fix a leg (O Lyllyn!?)

And painkillers! Think M-e has an herbal equivalent of morphine or vikodin (sp?)? What do you think, Lyllyn? I usually give patients some sort of undefined "draught" that usually makes them sleepy. It is possible that they imported opiates from the South--I've used such in previous stories. Is there some sort of painkiller he could take, that wouldn't make him dangerously woozy? After all, he's going to be riding a galloping pony. I dunno, Gypsum. He may just have to wait until after the race, at which time I suspect the head healer is going to haul him back to the infirmary by his ear and force a sleeping draught down his throat, or something like that...

 

 

Opium in M-e

Here's an interesting article I found a while back. It convinced me that it would be very plausible to have opium poppies growing in the parts of Middle-earth we're familiar with: The Poppy Paradox Elana

 

 

Re: How to fix a leg (O Lyllyn!?)

And painkillers! Think M-e has an herbal equivalent of morphine or vikodin (sp?)? What do you think, Lyllyn? I usually give patients some sort of undefined "draught" that usually makes them sleepy. I'm not up on herbs, unfortunately. The Willowbark tea (aspirin, basically) will help some, but not that much for truly severe pain. Looking over Elana's article, opium is possible (interesting nuzgul - drug abuse problems in the Shire!). Vicodin is a very modern compound. Morphine was first isolated in 1805 - reasonable for transferring it to the Shire. Things to be aware of: Opioids may cause your character to be sleepy. Taken orally, they can cause nausea, vomiting, and constipation, although it won't happen to everyone. The time honored formulation was laudanum, opium dissoved in wine or brandy. Lyllyn

 

 

Got another one for you!

Thanks for the info on laudanum. Might use that, it has possibilities. Now, for another story I'm working on. I have a hobbit (fairly young, in his late 20s or 30s, I think) in Minas Tirith stabbed with a sword through the chest. (Yes, poking out the other side, I think, and withdrawn again. yuck.) I want this to be a survivable wound--is it? (Not through the heart, obviously, and not through a major artery) I figured a chest wound would be more survivable than an abdominal wound, perhaps I'm wrong and will have to make it a sword through the arm instead... but then we get into arteries and tendons and things. Please advise. What would the healers in the Houses of Healing do? I imagine immediate first aid, for those around him at the time of the incident, would be to put a clean cloth on entrance and exit wounds, pressure to lessen bleeding and effect of pneumothorax (just threw that in, is it the right term?) Transport as quick as possible to Houses of Healing and then what? Treatment? Length of recovery? Complications? Prognosis for long term effects? (It would be nice if he could recover completely; how likely is that?) Thanks, Lin

 

 

Re: Got another one for you!

Lin, RL had me very busy today, and again tomorrow. In the meantime, there is some information in the Wounds article, but I suspect you've already looked. I'll get you something more specific Wednesday. lyllyn

 

 

Quick question

Hi Lyllyn, Just finished reading your articles and really enjoyed them all. They're all really informative and I think they'll all be a big help for me. I have quick question pertaining to wounds that I didn't see addressed in your wounds article. Is there ever a time that a healer would need to cauterize a wound, ie putting a small knife blade into a fire, then putting it into a wound to stop blood flow? (Hope I'm using the word 'cauterize' correctly!) My whole reason for asking this is that in my story I have a young Man who is stabbed in a skirmish about an inch below his left rib cage. And since his group is on the run from enemies, and there is no healer in the group, the only thing that is done is the wound is cleaned up as best as possible, some athelas is put into it, and it is bandaged up. It's not until about two or three days later that the group is able to get to their destination and have a skilled healer look at it. By then an infection has set in, but a scab has formed. So the scab is washed off so that the infection can be drained out, and the wound cleaned. It's then that I have the healer cauterize the wound so that will stop bleeding before sewing it up and bandaging it. (I haven't decided how deep the wound is yet.) Is that too drastic of an action and/or completely unnecessary? (I have more questions but will save them for later.) Thanks! Arquen

 

 

Re: Got another one for you!

I have a hobbit (fairly young, in his late 20s or 30s, I think) in Minas Tirith stabbed with a sword through the chest. (Yes, poking out the other side, I think, and withdrawn again. yuck.) I want this to be a survivable wound--is it? (Not through the heart, obviously, and not through a major artery) I figured a chest wound would be more survivable than an abdominal wound, perhaps I'm wrong and will have to make it a sword through the arm instead... but then we get into arteries and tendons and things. Please advise. It's a matter of the odds. There are historical accounts of people surviving such injuries, but most with this injury would die. However an abdominal injury that pierces the intestines is almost certain to kill, with the victim dying of infection within days. Depending on what your story needs, you could have a 'through & through' sword wound that hit a rib, and went only through skin and muscle - not entering the chest cavity at all. What would the healers in the Houses of Healing do? I imagine immediate first aid, for those around him at the time of the incident, would be to put a clean cloth on entrance and exit wounds, pressure to lessen bleeding and effect of pneumothorax (just threw that in, is it the right term?) If it is through the chest cavity, you must assume a pneumothorax. A cloth is not sufficient to seal the air leak. Since M-e won't have plastic or foil, a thick piece of leather is probably as close as you'll get, or maybe a piece of waxed tightly woven cloth; the healer would press that against the wound. He or she could bind it in place, probably by wrapping cloth bandages around the chest. This is tricky - wrap too tight and you restrict breathing. Another method would be to use some sort of gum or sticky substance to seal the edges of the leather or cloth against the skin. There really isn't a whole lot else a M-e healer could do. Keep the patient propped up or sitting, lying down makes it harder to breath. Make sure the patient is near an open window, no smoke from fires or anything else nearby. If he's indoors, an open window, and care to make sure the smoke goes up the chimney instead of into the room. The patient may or may not have a large amount of blood loss - you can choose small, medium or large. Length of recovery? Complications? Prognosis for long term effects? (It would be nice if he could recover completely; how likely is that?) Length of recovery - varies. Small pneumothorax and small blood loss: 1 to 2 weeks. Big pneumothorax - weeks. Big blood loss (didn't we just do this? ) about a month. Complications - big range. He could bleed to death within hours. He could progress to a tension pneumothorax and die. He could get infected and die. If none of these things happen, he has a good chance for the lung to reexpand, and he could totally recover. Lyllyn

 

 

Re: Quick question

Just finished reading your articles and really enjoyed them all. Thank you! That's the equivalent of a review for fiction, very much appreciated! Is there ever a time that a healer would need to cauterize a wound, ie putting a small knife blade into a fire, then putting it into a wound to stop blood flow? (Hope I'm using the word 'cauterize' correctly!) Yes, that is the correct understanding of 'cauterize.' My whole reason for asking this is that in my story I have a young Man who is stabbed in a skirmish about an inch below his left rib cage. And since his group is on the run from enemies, and there is no healer in the group, the only thing that is done is the wound is cleaned up as best as possible, some athelas is put into it, and it is bandaged up. It's not until about two or three days later that the group is able to get to their destination and have a skilled healer look at it. By then an infection has set in, but a scab has formed. So the scab is washed off so that the infection can be drained out, and the wound cleaned. It's then that I have the healer cauterize the wound so that will stop bleeding before sewing it up and bandaging it. (I haven't decided how deep the wound is yet.) Is that too drastic of an action and/or completely unnecessary? This is a difficult one, because you have a few medical problems here. Yes, the scab should be removed. It may not wash off, someone may have to remove it. From your discription there is pus underneath. That should be washed out, repeatedly. This is a circumstance where the healer would not want to put in stitches, because any foreign object in the wound will make it harder for the infection to resolve. Unless the bleeding will be life-threatening, put a cloth dressing on it and leave it open. The issue here with cautery is equally complicated. Cautery will stop bleeding, but it will also kill surrounding tissue. The dead tissue increases the risk of infection. If your story requires vigorous bleeding which needs cautery, cauterize the smallest area necessary to stop the bleeding. But before doing that, try the cloth and direct, prolonged pressure on the bleeding area. (I have more questions but will save them for later.) I'll watch for them. Lyllyn

 

 

Re: Quick question

Thanks Lyllyn! The info helps a lot. Now if only I can remember what my other questions are, I'll be good to go! (I hate when my mind turns to mush!) Arquen

 

 

Re: Quick question

Thanks Lyllyn! The info helps a lot. Now if only I can remember what my other questions are, I'll be good to go! (I hate when my mind turns to mush!) Arquen

 

 

Question about a battle wound

I will eventually be co-writing battle scenes again, oh joy, since I know next to nothing about battles or combat, etc. My co-writer wants to know if, when our hero (a Man of Numenorean/Dunedain descent, oh shoot, let's not be coy, it's poor Faramir and he's gonna get whomped again) gets an arrow wound that we want to be relatively minor, i.e. to the shoulder (not his sword-arm!) and not to any vital areas, and he insists on continuing to fight, would they take the time to get the entire arrow out, or just do some bandaging and leave it in until the battle is over? I'm also wondering how effective he could be as a fighter with an arrow in there, or an arrow removed? Also, would he eventually need to stop fighting, or risk shock from blood loss? And how many hours would it take for that blood loss to make him feel weak, if it's enough to have that effect. In this story, Faramir is middle-aged but in good physical condition. RAKSHA THE DEMON

 

 

Re: Question about a battle wound

Message I will eventually be co-writing battle scenes again, oh joy, since I know next to nothing about battles or combat Join the club! There are some good sites in the URL library that I've found helpful. As for poor Faramir, I'm going to need more information, but there's enough variation to set it up to get what you want out of it. ...gets an arrow wound that we want to be relatively minor, i.e. to the shoulder (not his sword-arm!) and not to any vital areas, and he insists on continuing to fight, would they take the time to get the entire arrow out, or just do some bandaging and leave it in until the battle is over? A key question here is can he drop out of the fight to get it tended to? If your life is in immediate danger, you keep fighting. If you can stop for a few minutes, someone should cut the arrow short, leaving about an inch or 2 to 3 cm above the skin. Then put some fairly thick dressing on it - a wadded up piece of cloth would be good - to stabilize and cushion the protruding piece. Then wrap the whole thing a few times. Taking the arrow out would likely need 15 to 30 minutes, if it was simple. Throw in certain complications and it could be over an hour. I'm also wondering how effective he could be as a fighter with an arrow in there, or an arrow removed? Depends. There are known cases of people continuing to fight with horrible wounds. If you're saying it's not his sword arm, and not hitting any vital organs, he could continue - it would be painful, though. Adrenaline does amazing things; sometimes people don't even realize they're badly wounded until afterwards. Also, would he eventually need to stop fighting, or risk shock from blood loss? And how many hours would it take for that blood loss to make him feel weak, if it's enough to have that effect. In this story, Faramir is middle-aged but in good physical condition. This is a case where you have lots of choice. He can get an arrow wound and not lose much blood at all, or it could hit a blood vessel and he could bleed profusely. Hit a large artery and he could bleed out very fast. You can set it up for whatever result you want. It would bleed more if he continued to fight, as the motion of the muscles will make it more difficult for the area to clot, but it doesn't have to mean he will lose large amounts of blood. HTH Lyllyn

 

 

Re: Question about a battle wound

Thanx, Lyllyn! I will send the info to my co-writer. She will be rough-drafting the battle scenes, so she would be able to figure how many more hours our hero will have to fight. I know that the entire battle lasts several hours. Don't think it's his sword-arm. I would also imagine that Faramir might have been in a similar position before, before the Ring-war, having been in many skirmishes and battles, of having to fight on despite a minor but painful wound. We might also want him to be laid up after the battle, to the extent that he can't do any riding for a week or two; but we're still working out the details of the plot (it's around ch. 26, and so far we've only posted through ch.7). Given the scenario I hypothesized, Faramir getting an arrow wound to the non-swordarm shoulder (left, I assume), no major arteries cut, or vital organs, and having the arrow cut short and bound up and continuing to fight; could Faramir still lift that left arm enough to heft his bow while he uses the the other arm to shoot arrows? There's a point in the battle where we need to have him demonstrate his archery abilities, and I should know whether he could or couldn't shoot. RAKSHA

 

 

Re: Question about a battle wound

could Faramir still lift that left arm enough to heft his bow while he uses the the other arm to shoot arrows? There's a point in the battle where we need to have him demonstrate his archery abilities, and I should know whether he could or couldn't shoot. This is a tough one, partly because I don't know enough about archery - hardly anything, actually. Maybe someone who knows archery can help us out - How much stress is on the bow-holding arm? What muscles are used by the bow-holding arm? If I knew that it could help select an injury that would allow what the story needs. Lyllyn

 

 

Re: Question about a battle wound

This discussion fits right in with one I had for a plot point in an upcoming story. I've got people out hunting, and they're using the kind of pyles (points) that are meant for large animals, such as deer. If you look at the point in two dimensions, it looks like a triangle with the bottom pushed up, so that you have one sharp point facing forwards and two sharp points facing backwards (barbs of a sort). There might be three backwards facing barbs, I cannot recall, or four, even. Will have to go back and look at my cheat sheets once more, from when I researched archery. Anyhow, where could a person possibly get hit with one of these and not suffer a mortal or crippling injury? Is it possible, especially if it is not a glancing blow and the arrowhead is buried somewhere in the person? I know that the treatment is to cut/break off the shaft and bind it in place so that it will move as little as possible and get the person to where surgery can be performed, and then they basically cut into the flesh and push the point through, doing as little damage as possible. The last thing you want to do is try to pull the arrow out. Anyhow, I need a hunting accident and I need to know if a main character can get hit by accident, or if I have to make up an OC if crippling injury is inevitable. Thanks! Lin (I don't know where I get these dark thoughts from...)

 

 

Re: Question about a battle wound

Anyhow, where could a person possibly get hit with one of these and not suffer a mortal or crippling injury? Is it possible, especially if it is not a glancing blow and the arrowhead is buried somewhere in the person? Lindelea, I'm not that good at visualizing - do you have a URL where I can see a picture? And yes, I'm sure we can make it non-crippling with careful choices. Bear in mind the velocity behind the arrow is an important part of how far it will penetrate and how much damage it will do. I know that the treatment is to cut/break off the shaft and bind it in place so that it will move as little as possible and get the person to where surgery can be performed, and then they basically cut into the flesh and push the point through, doing as little damage as possible. The last thing you want to do is try to pull the arrow out. You are quite right, you don't want to pull it out. In some circumstances it could be pushed through, as you describe. In others one would cut down to the barb, free it, and then draw it out. I'll elaborate on places after I understand more about the arrowhead, but any large muscle area is a possibility - thigh, buttock, calf, upper arm. Depending on the force behind it, it could hit the back and be blocked by the scapula (shoulder blade). On a very muscular man, if it came down from above it could hit the chest and bounce off rib, sticking in the muscle. Lyllyn

 

 

Re: Question about a battle wound

could Faramir still lift that left arm enough to heft his bow while he uses the the other arm to shoot arrows? There's a point in the battle where we need to have him demonstrate his archery abilities, and I should know whether he could or couldn't shoot. ---------------- This is a tough one, partly because I don't know enough about archery - hardly anything, actually. Maybe someone who knows archery can help us out - How much stress is on the bow-holding arm? What muscles are used by the bow-holding arm? If I knew that it could help select an injury that would allow what the story needs. Lyllyn Greetings all ~ Just wandering through when this topic caught my eye. If you will humor me, I thought I'd share some thoughts which come purely from reading, not practical experience. On the question of stress in the bow-holding arm, it is my understanding that as much stress is placed on that arm as on the arm drawing the string. The bow is both drawn and pressed at once, so that the string is pulled back while the bow-stave is pushed forward. Also, the bow arm must be able to hold that stress steadily through the moment of release, as any wobble or weakness will of course send the arrow astray. I would guess - and this is only a guess - that most of the major arm and shoulder muscles are involved in drawing a bow. The few archery hunters I've met have all had marvelously well-developed arms, not bulky but defined linear muscles. I have attempted to draw a couple modern (compound) hunting bows ... and could not do it. They were simply too heavy for my wee self to draw. So, there is a consideration to bear in mind. An arrow to the arm is going to be very painful and may weaken the arm it strikes, depending on how deeply and where it impacts. That could weaken the archer's ability to both come to full draw and hit what he's shooting at. Granted, as someone else noted adrenaline is a wonderful thing, allowing a fighter to blot out a lot of sensory information that in ordinary circumstances might put a person out of action entirely. Anywho, point here is - yes, I have a point, LOL! - that both arms are needed to draw and shoot a bow properly, especially the Rangers' powerful long bows, which Tolkien describes as being "great bows" almost as long as the men were tall. If either arm is significantly damaged / weakened, it will affect the archer's ability. Shutting up now ..... ;) Cheers ~ Erin

 

 

Re: Question about a battle wound

On the question of stress in the bow-holding arm, it is my understanding that as much stress is placed on that arm as on the arm drawing the string. That's what I would have guessed -- with no archery knowledge whatsoever -- just from the physics of the situation... Equal and opposite forces... So, I heartily recommend introducing an OC wearing a red Federation uniform to the away-team... - Barbara (Besides, red makes such an attractive target...)

 

 

Re: Question about a battle wound

I'll elaborate on places after I understand more about the arrowhead, but any large muscle area is a possibility - thigh, buttock, calf, upper arm. Depending on the force behind it, it could hit the back and be blocked by the scapula (shoulder blade). On a very muscular man, if it came down from above it could hit the chest and bounce off rib, sticking in the muscle. Here is a website showing hunting points such as those that might be used in deer-hunting. It took a while to load on the computer I was using at the time but the pictures are pretty clear. Of course, we're talking M-e equivalents, but I bet a good smith could come up with some of these types of points. http://www.archeryhistory.com/broadheads/broadheads.htm Thanks! Lin

 

 

Re: Question about a battle wound

Sorry for the delay - I'm in the midst of a busy time. I've looked at the hunting points (nassssty things they are, precious). From a brief web search - no time to do more - there are bowhunter sites that say using hunting points and even a fairly light bow a hunter can see one of these pass completely the animal. This will obviously do some damage. If it's going to be a through and through, I'd recommend the buttock. If you want to postulate it's at the end of the range, so much force is spent, you could choose the back and have it blocked by the scapula. If it had a fair amount it could still be embedded in the scapula - harder to remove. You can use the other large muscles I mentioned, but with that kind of a point something through the calf would leave him limping badly for a week or two, similar for the thigh. HTH Lyllyn

 

 

Re: Question about a battle wound

Faramir getting an arrow wound to the non-swordarm shoulder (left, I assume), no major arteries cut, or vital organs, and having the arrow cut short and bound up and continuing to fight; could Faramir still lift that left arm enough to heft his bow while he uses the the other arm to shoot arrows? There's a point in the battle where we need to have him demonstrate his archery abilities, and I should know whether he could or couldn't shoot. Raksha, from the answers that ErinRua and ElenaTiriel have kindly given, there is equal stress on his bow holding arm as on the drawing arm, so it becomes far more difficult. The best I could figure, if you absolutely need this to unfold this way, is to put an arrow into the large chest muscle, but not have it go deeper. If you pinch the area on your chest right next to arm, you'll see there's a chunk of muscle where something could hit or even go through and not go into the rib cage. You could use this. It would make it painful for him to lower his arm to his side, and to reach across his body. If it will help, I'll post a URL to an illustration. Lyllyn

 

 

Re: Question about a battle wound

Lyllyn and ErinRua and ElenaTiriel; thanx much for your input. Meanwhile, my co-writer decided that Faramir should be wounded in the thigh. He'll stop fighting long enough to have the shaft broken off and the wound bandaged, and then eventually get it cleaned and cared for when the battle's over. He will have to last a few hours fighting, probably not constant, on his feet. Hope that's feasible. I'm assuming that there are parts of the thigh that don't have important arteries or muscles....But at least he'll be able to thwack away with bow and arrow, and use his sword. RAKSHA

 

 

Re: Question about a battle wound

Lyllyn and ErinRua and ElenaTiriel; thanx much for your input. Meanwhile, my co-writer decided that Faramir should be wounded in the thigh. He'll stop fighting long enough to have the shaft broken off and the wound bandaged, and then eventually get it cleaned and cared for when the battle's over. He will have to last a few hours fighting, probably not constant, on his feet. Hope that's feasible. I'm assuming that there are parts of the thigh that don't have important arteries or muscles....But at least he'll be able to thwack away with bow and arrow, and use his sword. RAKSHA You are very welcome! LOL, moveable wounds - we are a goofy lot, ain't we? I'd imagine one could be wounded in the thigh and still be functional. The femoral artery is somewhat to the inside, so a shot from an indirect angle would hopefully avoid that. (Otherwise one bleeds out in just minutes - erks!) Being familiar with horse-kicks to the thigh, though, I can say that any solid blow or wound is going to be inhibiting, so while Faramir may be able to continue on, he'll be limping and hurting, easily losing some agility of movement, especially if the arrowhead is left in to sort of grind around. On the other hand, I suppose you could always have it a somewhat glancing wound, too, rather than driving it directly in. As someone else noted, if the arrow were actually at the end of its range, it will lack the punch of if it were fully within range. Thus the arrow could strike from an angle, or even falling at the end of its arc, and do some muscle-and-flesh tearing, but not drive deep enough to really inhibit movement or require a lot of gouging to get the arrow out. Even as bullets are capable of glancing blows and 'flesh wounds', so is an arrow. So nothing says your arrow has to strike directly and full-force, unless you want it to. I'll leave it to our medical whizzes to address the actual ramifications of projectiles to the thigh muscles, though. :-) Cheers ~ Erin

 

 

Re: M-E First Aid

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M-e first aid

Gives big newbie wave. Very impressive and detailed resource, here. Okay. I'm kicking around an idea for a fic where the narrator is a young healer in the Houses of Healing during the Siege of Gondor. This means she's going to have deal, quickly, with a wide variety of battle wounds and their complications. 1.) What are some readily-available herbs which would have served as relatively easy remedies for pain? Are there any herbs that would have been used for euthanizing purposes? 2.) How prevalent was the practice of amputation in medieval medicine? Did they know about gangrene and other infections? How safe/sterile would these amputations have been? 3.) What about stitches in a "triage" situation? How large/severe would a cut or laceration have to be for it to require stitches? Also, if anyone knows of any glaringly obvious medieval battle injury issues that I've totally overlooked, please point 'em out. Thanks, Ali

 

 

Re: Question about a battle wound

Femoral artery bad zone is on the inner thigh near the groin if I recall correctly. Absolutely right, ErinRua and Blue Iris! There are some large muscles in the thigh on the front and the side, while an arrow could lodge without doing other damage. It would hurt a lot, and he might limp some. If he has to be on his feet for a long time it's going to be difficult, though not impossible. And Blue Iris's excellent point about Numenorean blood could also mean he might have a higher pain tolerance. Lyllyn

 

 

Re: More Medical questions and terminology

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Re: M-e first aid

Gives big newbie wave. Very impressive and detailed resource, here. Welcome! 1.) What are some readily-available herbs which would have served as relatively easy remedies for pain? Are there any herbs that would have been used for euthanizing purposes? I regret that I'm not very knowledgeable about herbs. Willowbark is the source of aspirin, and will help with pain, but will also inhibit clotting. Alcohol might help some, but it's not a particularly good pain reliever. The best possibility is an opiate, derivative of the opium poppy. Further up this page, message 26025, Elana posted a link which explains how easily opium poppies can be grown in various climates. So Gondor could easily have laudanum or another opiate. Lots of things could be used for euthanasia. Some available poisons are hellebore, yew, hemlock, aconite, nightshade. Foxglove in a large enough dose would work also. Here is a good site for poisons: Stefan's Florilegium. 2.) How prevalent was the practice of amputation in medieval medicine? Did they know about gangrene and other infections? How safe/sterile would these amputations have been? Amputations have been performed from very early times, with evidence for amputations from 2000 BC in Egypt. People certainly knew about infections, and by the 1600's, there was some understanding of the importance of removing it, but not of how people got infections. Up until the 1800's, the importance of sterility was not known by western medicine. OTOH, Aragorn is always boiling water and cleaning things, so you can certainly use cleanliness, although sterility is likely to be stretching it too far. 3.) What about stitches in a "triage" situation? How large/severe would a cut or laceration have to be for it to require stitches? Pretty big. The standards of triage require that you divide the injured into three groups: Those who will die no matter what, so you don't bother with anything but comfort care Those with life or limb-threatening injuries who will survive only if they receive rapid care Those who need care but can wait for it So in a triage situation the healer will only stitch someone who'll die or lose a limb if she doesn't. This would be lacerations with: continuing copious bleeding, shattered bone, or lots of dead tissue which needs debridement or the risks of infection increase dramatically. Anything else would wait until the ife or limb-threatening injuries were cared for. Also, if anyone knows of any glaringly obvious medieval battle injury issues that I've totally overlooked, please point 'em out. Hard to say. I'll echo Blue Iris and suggest looking at the Medicine articles in the Resources section, one of which is devoted to wounds. It may help you think of other issues or questions to ask. Thanks, Ali You are most welcome! Lyllyn

 

 

Re: M-e first aid

Thanks Blue Iris and Lyllyn! Very shortly after I made that post, I also stumbled upon Lyllyn's excellent series of medical articles on this site, and those should prove very useful indeed. ...though would question deliberate euthanasia in ME. As would I. My "gut feeling" (no pun intended) tells me that deliberate euthanasia would not be a regular practice in the Houses of Healing, but I'm toying with the idea of having a character who does it, anyway. I don't think it would be a central issue to the plot, but it occurred to me today as an interesting way to add a few wrinkles to the story's moral fabric. Cheers, Ali

 

 

Re: More Medical questions and terminology

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Re: M-e first aid

Hello Newbie here, and not quite sure how relevant this will be, so ignore me if you like! Your point on euthanasia interests me because I've just finished a final paper on the legal ethics of it, and while I thought I had pretty defined views on the issue before I started my research, they're a lot less defined now that I've read up on it. I think "legal" euthanasia (I mean, where it's an accepted and standard practice) would probably not have existed in M-E, or the Houses of Healing, at least. However, I think it would still occur, based on the intuition of the healer and the circumstances involved. For example, if it *is* during a war, where there are many casualties and a shortage of staff and resources, I think it's probable there will be many painful injuries that will *not* be able to be healed. The patient will die despite everything that can be done for them, and they may die painfully, over a long period of time. In these cases, I think it might have been acceptable to quiety and quickly end a life, to prevent further suffering? Of course, there is always the argument that life is sacred, and should *never* be prematurely ended; that any life is better than no life; that spirtual enlightenment can be born from suffering. And also, there are those who *will* not, or *cannot* take a life, even if they think it might be just justifiable. And there are those who look at the purely practical circumstances and think - "This person is dying, and he is dying painfully. I cannot do anything to stop him dying, but perhaps I can stop the pain." I'm making no assumptions about which one is right, though. These are just the most prevalent attiudes that I've come across in regards to this subject! And one last point: there is the doctrine of double effect. This is where a healer gives the patient a large dose of something like morhpine/opium as a last resort to kill strong pain. It is the only thing that will work, but it will also result in killing the patient/sending him into a coma/significantly shortening his lifespan. The difference between double effect and outright euthanasia is that the *intent* of the double effect is to relieve pain/suffering, with the unintended but known consequence that death will be hastened, while the *intent* of euthanasia is to bring about the death of the patient (to relieve pain/suffering). Those who do not subscribe to euthanasia may still use the principle of double effect. Whether there actually is a moral/practical difference is up to each individual to decide. I hope that was helpful, but that's probably more than anyone ever wanted to know about euthanasia! sidhe

 

 

Re: M-e first aid

Hello Newbie here Welcome, Sidhe You raise very good points. I'd expect M-e healers to give the large dose with the intent of relieving pain, and not worry if that hastens an inevitable death. This is particularly interesting because Tolkien, as a catholic, could be expected to oppose euthanasia and suicide. Yet he gave the Elves a form of 'suicide' with the ability to die as a result horrible situations - rape, for instance. In another instance, I believe Fingon was very close to killing Maedhros to stop his torment when the eagle intervened. Lyllyn

 

 

Re: M-e first aid

Ohh! I'm quite possibly about to get more excited about euthanasia than anyone in their right mind has a right to be. lol Tolkien on the subject of suicide was one major thing going through my head as I was writing the essay! Partly cos I'm a geek, and partly cos I'd just discovered HASA/HA then. But do you think Tolkien would be opposed? As a Catholic he might be, but then, from the arguments I've read, being Catholic isn't necessarily a bar to being a proponent of euthanasia. I haven't finished the Silmarillion yet, so I don't know about your Fingon/Maedhros example, but I was also thinking of the elves/suicide thing. (I'm going to assume that euthanasia in this sense means "active voluntary euthanasia", where the patient actually requests that his/her life be ended, and equate that with suicide.) And even apart from elves dying as a result of rape (or a broken heart... would that be the same as extreme depression? Or actually more physiolgical/physical? Or spiritually damaging?), I was wondering if (and, this is a very long shot, since I'm not very familiar with either Tolkien mythology or Christian belief) the elves departing to Valinor is something akin to going to heaven? I mean, giving up on a situation they are wearied of or don't want to be in anymore, and removing themselves from it forever? Would that be something like suicide, but with the uncertainty of "what happens after death?" completely removed? My other thought was Aragorn's death. IIRC, he chose to die when he was 310, and when Arwen(?) begged him not to, he said something along the lines of, he'd rather die gracefully while he still could, rather than becoming witless and unmanned? (Ack, I've only read RotK once, and that was 2 years ago, and I don't have it on me!). Isn't that the ultimate suicide - giving up life while it's still wonderful, knowing that descent is about to come? It's certainly a much more dignified way to go, but it also strikes me as a little odd - why give up life just because you anticipate that old age is coming, or upon you? When Arwen had given up her immortality to live as long as he lived, might it not have been more valiant to stay and age (gracefully or ungracefully) with her, for as long as he possibly could, before dying and taking the meaning out of her life? As far as I can recall (admittedly, not far), Aragorn didn't seem to be notably senile or anything when he chose to die. I wonder if something prompted him to make the decision, *then*? Because if he didn't seem senile, and if his health wasn't too bad, then why choose to die at that particular point? And why on his birthday? I think this might be very off-topic now, but I'm not sure what to do about it... What is the common ettiquete here for a post that's not on-topic? Should I remove it to somewhere else, or just leave it? Or create a new discussion and add a link to that? Sorry, my newbieness showing itself again. lol. But thank you for the opportunity to discuss something that's been preying on my mind these past few weeks! And, I'm glad I'm not alone in thinking there might, perhaps, have been references to suicide/euthanasia in Tolkien! sidhe

 

 

Re: More Medical questions and terminology

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Re: M-e first aid

Thank you, sidhe, Lyllyn, and Iris, for the thought-provoking points. This is more food for thought than I expected, and all the better for it! Agreed, but in a siege/battle setting, overwhelmed with casualties, the Houses of Healing might well have been taxed to their limits or if early in the action working on forward planning with what they have. This raises another question: in such a chaotic, intense battle as the Siege/Pellenor (although all battles are intense and chaotic, I suppose), who would actually be able to make it to the Houses of Healing? If a soldier were too badly injured to get up and move himself in the heat of the battle, would his friends be forced to leave him, because if they tried to bear him away, they'd be cut down, themselves? I don't pretend to understand the mechanics of the entire massive thing, but it seems to me that this might be the case in many individual situations, particularly if they had to keep falling back. (Unless of course, said soldier happens to be the Steward's son or the niece of a King) I guess what I'm trying to say ask is, how many of the patients in the Houses of Healing would be the "walking wounded," and how many would be critical cases who couldn't reach the Houses under their own power? Sorry, am I even making any sense? It's late over here.

 

 

Re: M-e first aid

I guess what I'm trying to say ask is, how many of the patients in the Houses of Healing would be the "walking wounded," and how many would be critical cases who couldn't reach the Houses under their own power? Hmm. Disclaimer first, that I really don't know much "factual" information about this, and my response is only my best guess! I guess if a particular battle is on, there might be medical tents pitched near the battlesite, especially afte the battle is over. During the battle, I'm guessing there might be medical tents set up as close as they could manage to the scene, without actually being in danger. During the battle itself, I'd guess that those who fell, were left where the fell. Afterwards, if there was victory for the men, they would go collect their dead and wounded. If it was a battle between men and men, I think there might be some sort of truce where both sides could do that, but if it was a battle between men and orcs, I doubt that would happen... In that case, I'm assuming most of the medicine practiced during a battle is field medicine? I think you're right when you assume that the average soldier wouldn't physically ever make it to the houses of healing, at least in the initial stages after a battle. So: * Important people get rushed straight to the HoH, after stabilizing first aid. * The average soldier gets what help he can onsite of the battle. * If it's not a serious matter, field medicine might be all that he can get? * If it *is* serious, and he doesn't die during it, he might then be moved up to the HoH for more detailed care. Would that sound about right?

 

 

Re: M-e first aid

This is particularly interesting because Tolkien, as a catholic, could be expected to oppose euthanasia and suicide. AFAIK there was/is a ruling in the Catholic church which basically says that while as Catholics we are not allowed to deliberately end our lives we do not have to agree to extreme measures to prolong them. Back in Medieval times this was taken, for example, to mean that one did not have to agree to an amputation which might prolong life but which would also be extremely painful. It was this ruling that Karen Ann Quinlan's family considered before making their request for her life support to be turned off. The healer's situation you are discussing would, I believe, sort of come under that. The other thing of course is that being Catholic doesn't mean that Tolkien 100% agreed with every tenet. I'd guess that he didn't see suicide as the worst of sins or he wouldn't have written some of the things he did - the Elves' ability to die, for example. Avon

 

 

Re: M-e first aid

So: * Important people get rushed straight to the HoH, after stabilizing first aid. * The average soldier gets what help he can onsite of the battle. * If it's not a serious matter, field medicine might be all that he can get? * If it *is* serious, and he doesn't die during it, he might then be moved up to the HoH for more detailed care. Would that sound about right? Yes, I think that's about what would happen. And even for Important People, they often have to wait for a lull in the battle so someone can get to them and move them. One thing that would also happen is that many soldiers realize they need care but can wait. Their superior officer or non-com superior will direct them, one or two at a time, to the healers after the worse of the casualties are cared for. So for a day or two afterwards you'll have people showing up to the healers. Most of those with minor injuries might show up at a healers tent or informal field station, rather than the HoH. I also agree with Blue Iris, if the amount of opiates are limited, the dying might not get them. It would be a grueling choice for the healers, though, if someone was in agony. Hey, you wanted moral wrinkles, this could be another... Lyllyn

 

 

Re: M-e first aid

Avon, The other thing of course is that being Catholic doesn't mean that Tolkien 100% agreed with every tenet. I'd guess that he didn't see suicide as the worst of sins or he wouldn't have written some of the things he did - the Elves' ability to die, for example. Agreed, hence my weasely "could be expected". I know he was very religious, but he also insisted he was trying to create something different from what he knew, not reproduce catholicism in M-e. This would give an interesting chance for someone to experiment with those ideas, surely. Sidhe, But do you think Tolkien would be opposed? As a Catholic he might be, but then, from the arguments I've read, being Catholic isn't necessarily a bar to being a proponent of euthanasia. Avon or someone else might be able to answer this better, but my understanding is that on the whole, a Catholic would not be a proponent of euthanasia. I was wondering if (and, this is a very long shot, since I'm not very familiar with either Tolkien mythology or Christian belief) the elves departing to Valinor is something akin to going to heaven? I mean, giving up on a situation they are wearied of or don't want to be in anymore, and removing themselves from it forever? Would that be something like suicide, but with the uncertainty of "what happens after death?" completely removed? I would say something akin to heaven, yes. But I believe a religious catholic also would be certain as to what happens after death - that is part of the core of the religion. As to Aragorn, there is more information in Unfinished Tales that adds to this. The Numenoreans are especially long-lived, but once they get to a certain point, they deteriorate very fast; not like a RL old age. Tolkien has it as part of the shadow falling on Numenor that some kings clung to life past their time. So when Aragorn feels the approach of that deterioration, he accepts the 'gift of Iluvatar' [death] and dies, which is held nobler than not. If we continue this discussion, we should start a new thread and copy the posts. It's about time for a new medical questions thread, as well. Lyllyn

 

 

Re: M-e first aid

I guess if a particular battle is on, there might be medical tents pitched near the battlesite, especially afte the battle is over. During the battle, I'm guessing there might be medical tents set up as close as they could manage to the scene, without actually being in danger. During the battle itself, I'd guess that those who fell, were left where the fell. Afterwards, if there was victory for the men, they would go collect their dead and wounded. If it was a battle between men and men, I think there might be some sort of truce where both sides could do that, but if it was a battle between men and orcs, I doubt that would happen... In that case, I'm assuming most of the medicine practiced during a battle is field medicine? I think you're right when you assume that the average soldier wouldn't physically ever make it to the houses of healing, at least in the initial stages after a battle. Greetings all ~ Sneaking in one more response to this thread, if you'll forgive me. I've some observations to make of my own, mostly stemming from my reading of the American Civil War but I think pertinent to most battles/wars prior to 1900. You are right that where they fell is where they lay. During actual battle there was no provision for the wounded, and only the crudest medicine practiced, if at all. Battlefield medics with their handy first aid kits did not exist, nor did surgeons stand waiting in the wings - unless it was the king's own, perhaps. There were no medical tents, no triage, no M.A.S.H units. If a man fell wounded in battle, he was just as likely to be trampled, since anyone stopping to help him might be killed. Remember, these types of battles with swords, axes, pikes, and halperds swiftly devolved to giant melees, enormous brawls, unlike soldiers standing off 200 yards apart shooting at each other. A wounded man could only hope that he could crawl to cover, (or perhaps comrades could drag him to cover) and maybe later a comrade could safely stop to aid him. War accounts are filled with grim tales of the wounded crying out on the field, because no one could reach them and it was unsafe for anyone to expose himself to enemy attack. Yes, sometimes truces were called in which to go out and collect the wounded, but that depended on how bitter the enmities were. Sometimes soldiers simply killed enemy wounded. Also, without proper bandages or first aid kids, "field medicine" would be in the very loosest sense, just hastily tying a rag as a bandage or tourniquet. A person of very high rank, such as a king or nobleman, would probably be scooped up and carried off as quickly as his men could secure him and create the space to move. But everyone else ... is pretty much stuck on the field, unless he can crawl off out of the way. As Tolkien makes no mention of any battlefield medics at all, and the first-responders to Theoden and Eowyn were other soldiers, I think it's safe to presume that's how it was on the Pelannor in general. Wounded nobles might be whisked to safety, but the ordinary grunt was kinda screwed. Once the battle ended, as we see throughout history, there is the timeless image of comrades combing the fields for the fallen of their companies, and civilians and widows looking for loved ones. Nor was it uncommon for civilians living near the battlefield to offer their own homes as makeshift hospitals - or for barns or outbuildings to be commandeered by the troops as impromtu field hospitals. But the only surgeons after the Pelannor Field would have to be either staff from the Houses of Healing, soldiers who happened to have experience as healers, or local citizenry who could render aid and perhaps take wounded in. For myself, I have always thought that any soldier in need of serious medical aid would be brought to the Houses of Healing. When Aragorn rises from healing Faramir, Eowyn and Merry, he is shortly thereafter confronted by a literal throng of people pleading for him to help their wounded, whereupon he and Elrond's sons worked all night. (As I'm sure did the rest of the Houses' staff.) Thus I've imagined the Houses as the Emergency Room of Middle-earth, so to speak, with all the worst cases being brought there, regardless of rank or lack thereof. Umm, and did I say anything remotely useful, or did I just sort of mutter and repeat things other folks have already said? Going away, now ... Cheers ~ Erin

 

 

Re: M-e first aid

Thanks again, sidhe, Lyllyn, Avon, and Erin. Umm, and did I say anything remotely useful, or did I just sort of mutter and repeat things other folks have already said? No, that was very interesting and helpful for me to read! For myself, I have always thought that any soldier in need of serious medical aid would be brought to the Houses of Healing. When Aragorn rises from healing Faramir, Eowyn and Merry, he is shortly thereafter confronted by a literal throng of people pleading for him to help their wounded, whereupon he and Elrond's sons worked all night. (As I'm sure did the rest of the Houses' staff.) Thus I've imagined the Houses as the Emergency Room of Middle-earth, so to speak, with all the worst cases being brought there, regardless of rank or lack thereof. That makes sense to me, too. I was also re-reading "The Siege of Gondor," and Tolkien describes the period shortly before the actual assault on Minas Tirith starts, when the outer defenses are falling one by one; in this period, wounded survivors come back to the city in small groups, and he also describes Gandalf escorting a "line of wains" bearing the wounded from the attack on the Causeway Forts, so I suppose we can also assume that the staff in the Houses had their hands full even before the Siege had officially begun. Thanks again, you guys-- I now feel a lot better about hammering together a (hopefully) credible picture of what the Houses of Healing were like during throughout the War of the Ring. (And sorry, I'll start a new topic if I've got anything else-- promise! ) Ali

 

 

I started a new thread

Since this thread has become rather long and unwieldy, I started a new one, it can be found here. fliewatuet

 

 

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